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Elisa F, Davide T, Luisa SM, Martina M, Tommaso B, Luis SC, Barbara D, Morena F, Giulio C. Outcome analysis on individual health budgets in mental Health: finding from the Friuli Venezia Giulia Region, Italy. J Ment Health 2024; 33:159-168. [PMID: 37177819 DOI: 10.1080/09638237.2023.2210657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Individual Health Budget (IHB) is used for social and health integration and to facilitate processes of resource reorientation in healthcare. Despite its increased use in mental health settings, few studies investigated its effectiveness in severe mental disorders. METHODS 383 IHB beneficiaries were recruited among Mental Health Departments users of the Italian region Friuli Venezia Giulia. Data involved sociodemographic and clinical variables, IHB type and scores of Health of the Nation Outcome Scale (HoNOS) at admission to IHB programme (T0), after 12 months (T1), and after 24 months (T2). RESULTS The length and the mean number of hospitalisations and healthcare interventions decreased at T1. A significant scores' reduction from T0 to T1 evaluation was found in HoNOS total score (T-test (P) < 0.05) and in most of its items. An improvement throughout the whole evaluation period (T0 vs. T2) was found in 36% of the IHB beneficiaries, while more than 60% of them remained in the same HoNOS severity category. CONCLUSIONS Our results support the use of IHB in patients with severe mental problems, since it may contribute to an improvement in social and clinical functioning, consequently lowering the burden on MHDs.
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Affiliation(s)
- Fontecedro Elisa
- Mental Health Department, Health University Agency of Udine, Udine, 33100, Italy
| | - Tossut Davide
- Welfare Area, Friuli Venezia Giulia Region, Palmanova (UD), Italy
| | - Scattoni Maria Luisa
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Micai Martina
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Bonavigo Tommaso
- Mental Health Department, Health University Agency of Trieste, Trieste, Italy
| | - Salvador-Carulla Luis
- Health Research Institute, Faculty of Health, University of Canberra, Bruce Campus Canberra, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney
| | | | - Furlan Morena
- Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy
| | - Castelpietra Giulio
- Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
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Mirza M, Verma M, Aggarwal A, Satpathy S, Sahoo SS, Kakkar R. Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings. BMC Health Serv Res 2024; 24:42. [PMID: 38195544 PMCID: PMC10777560 DOI: 10.1186/s12913-023-10454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION With the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings. METHODS A two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance. RESULTS Existing IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level. CONCLUSION IMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.
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Affiliation(s)
- Moonis Mirza
- Department of Hospital Administration, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Arun Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sidhartha Satpathy
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
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Robinson M, Blaise M, Weber G, Suhrcke M. The Effects and Costs of Personalized Budgets for People with Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16225. [PMID: 36498302 PMCID: PMC9739011 DOI: 10.3390/ijerph192316225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
This article reviews the peer-reviewed and grey literature published from January 1985 to November 2022 that has quantitatively evaluated the effects of personalized budgets for people with disabilities (PwDs), in terms of a range of benefit and cost outcomes. Benefit metrics of interest comprised measures of well-being, service satisfaction and use, quality of life, health, and unmet needs. A search was conducted using the PsycINFO, MEDLINE, CINAHL, ASSIA, and Social Care Online databases. Based on inclusion criteria and a quality assessment using the Downs and Black Checklist, a final count of 23 studies were identified for in-depth review. Given the heterogeneous nature of the studies, a narrative synthesis, rather than a formal meta-analysis, was undertaken. Taking the relatively scarce and often methodologically limited evidence base at face value, the findings suggest that-overall-personalized budget users tend to benefit in terms of well-being and service satisfaction outcomes, with the exception of mixed effects for people with mental health conditions. Only a minority of studies have investigated the cost-effectiveness or costs-only of personalized budgets, finding mixed results. Two out of the three cost-effectiveness studies find personal budgets to be more cost-effective than alternative options, meaning that the possibly higher costs of personalized budgets may be more than outweighed by additional benefits. Some evidence looking at service use and/or costs only also points to significant reductions in certain service use areas, which at least hints at the potential that personalized budgeting may-in some cases-entail reduced costs. Further research is needed to explore the generalizability of these conclusions and to better capture and understand the factors driving the observed heterogeneity in some of the results.
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Affiliation(s)
- Marguerite Robinson
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
| | - Marie Blaise
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
| | - Germain Weber
- Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Marc Suhrcke
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Pattyn E, Werbrouck A, Gemmel P, Trybou J. The impact of cash-for-care schemes on the uptake of community-based and residential care: A systematic review. Health Policy 2020; 125:363-374. [PMID: 33423802 DOI: 10.1016/j.healthpol.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Internationally, deinstitutionalization and the provision of community-based care are growing policy aims. Several developed countries have thus introduced cash-for-care schemes, which turn the traditional funding stream from the perspective of the care provider around, giving purchasing power to care users. This review explores whether cash-for-care schemes encourage the shift towards deinstitutionalization. METHODS Ten databases covering medical, nursing and social science journals were systematically screened up to July 10, 2020. Only peer-reviewed articles written in English or French and containing empirical evidence on the uptake of care services in a cash-for-care scheme were included. RESULTS The search resulted in 6,865 hits of which 27 articles were retained. Most studies took place in the United Kingdom or the United States. Overall, the search showed mixed results concerning the uptake of the different types of community-based care. CONCLUSION Evidence demonstrating a higher uptake of informal, respite or home care individually, is scarce and inconclusive. A reduction in residential care and an uptake of services in the community can, with caution, be noted. However, contextual and individual factors can affect the way deinstitutionalization takes place and which community-based services are chosen. Future research should therefore focus on the underlying processes and influencing factors, in order to obtain a clear view of the shift towards deinstitutionalization.
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Affiliation(s)
- Eva Pattyn
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Amber Werbrouck
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paul Gemmel
- Department of Marketing, Innovation and Organization, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - Jeroen Trybou
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Fontecedro E, Furlan M, Tossut D, Pascolo-Fabrici E, Balestrieri M, Salvador-Carulla L, D’Avanzo B, Castelpietra G. Individual Health Budgets in Mental Health: Results of Its Implementation in the Friuli Venezia Giulia Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145017. [PMID: 32668599 PMCID: PMC7400620 DOI: 10.3390/ijerph17145017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
Background: Individual Health Budget (IHB) is an intervention for recovery in mental health services, providing personalized care for subjects with severe disorders and complex needs. Little is known on its effectiveness and on the criteria for its delivery. Methods: A total of 67 IHB beneficiaries and 61 comparators were recruited among service users of the Mental Health Department of the Trieste Healthcare Agency, Italy. Data included sociodemographic and clinical variables, type of IHB, and Health of the Nation Outcome Scale (HoNOS) scores. Results: A comparison between groups showed significant differences in several socioeconomic and clinical characteristics. Multivariate logistic regression showed that IHB was positively associated to the 20–49 age group, single status, unemployment, low family support, cohabitation with relatives or friends, diagnosis of personality disorder, and a higher number of hospitalizations. The IHB group was at a higher risk of severe problems related to aggressive or agitated behaviors (OR = 1.4), hallucinations and delusions (OR = 1.5), and impairment in everyday life activities (OR = 2.1). Conclusions: IHB was used in patients with severe clinical and social problems. More resources, however, may be aimed at the working and social axes. More research is needed to better assess clinical and social outcomes of IHB and to adjust their intensity in a longitudinal perspective in order to enhance cost-effectiveness.
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Affiliation(s)
- Elisa Fontecedro
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
| | - Morena Furlan
- Central Health Directorate, Friuli Venezia Giulia Region, 34100 Trieste, Italy;
| | - Davide Tossut
- Welfare Area, Friuli Venezia Giulia Region, 33057 Palmanova, Italy;
| | - Elisabetta Pascolo-Fabrici
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
- Mental Health Department, WHO Collaborating Centre for Research and Training in Mental Health, Health University Agency of Trieste, 34100 Trieste, Italy
| | - Matteo Balestrieri
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 2601 Canberra, Australia;
- Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre, The University of Sydney, 2006 Sydney, Australia
| | - Barbara D’Avanzo
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, 20156 Milano, Italy;
| | - Giulio Castelpietra
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; (E.F.); (M.B.)
- Central Health Directorate, Friuli Venezia Giulia Region, 34100 Trieste, Italy;
- Correspondence: ; Tel.: +39-040-377-5575
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Affiliation(s)
- Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Anita Charlesworth
- Health Foundation, London, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
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Laver K, Gnanamanickam E, Whitehead C, Kurrle S, Corlis M, Ratcliffe J, Shulver W, Crotty M. Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens' jury. J Health Serv Res Policy 2018. [PMID: 29523047 DOI: 10.1177/1355819618764223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.
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Affiliation(s)
- Kate Laver
- 1 NHMRC-ARC Dementia Research Development Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Emmanuel Gnanamanickam
- 2 Research Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Craig Whitehead
- 3 Director of Rehabilitation and Aged Care, Southern Adelaide Local Health Network, South Australia
| | - Susan Kurrle
- 4 Curran Chair in Health Care of Older People, Faculty of Medicine, University of Sydney and Hornsby Ku-ring-gai Hospital, Australia
| | - Megan Corlis
- 5 Director Research and Development, Helping Hand Aged Care, South Australia
| | - Julie Ratcliffe
- 6 Professor of Health Economics, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Wendy Shulver
- 2 Research Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Maria Crotty
- 7 Professor of Rehabilitation, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
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